Loss of engagement in controlling chronic anticoagulation therapy during Covid-19 stringency measures. A single center experience of disproportioned increase of stuck mechanical valves

Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication. We present a series of 10 patients who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization were necessary. Particularly with the COVID-19 restrictions in place, these cases highlight the need for physicians to be aware of the dramatic increase in the incidence of stuck prosthetic valves in patients on chronic warfarin therapy.

Post operative echocardiographic follow up after mitral valve replacement by different types of biological valves

Objectives This retrospective study compares porcine with bovine bioprosthesis in mitral position with regard to valvular degeneration. Methods Between 2005 and 2019, 15 patients underwent mitral valve replacement with porcine Epic biological valve (St-Jude) and 15 patients underwent mitral valve replacement by bovine Carpentier –Edwards Perimount biological valve and follow up ecocardiogarphy was done to evaluate valvular degeneration of both types Results Bovine type showed longer durability than porcine and less valvular degeneration within 14 years of follow up regardless age of patient, cause of valve replacement, or lesion of valve Coclusion: Bovine bioprothesis are better than porcine regarding durability

Patient Prosthesis Mismatch in Double Valve Replacement - A Retrospective Study at a Tertiary Care Center in Bangalore

BACKGROUND Valve replacement has become the mainstay of management for rheumatic heart diseases. However, an important and frequent complication of valve replacement is patient prosthesis mismatch (PPM). The present study was undertaken to evaluate a single institution experience on the clinical pattern and presentation of PPM, and the outcomes of double valve replacement surgery. METHODS This retrospective, regional study was carried out among 316 consecutive patients who underwent concomitant aortic and mitral valve surgery (with or without tricuspid annuloplasty) in this tertiary care hospital. Particulars regarding the clinical profile and procedure details (valve types and sizes and priority of surgery) of these patients were documented from the medical records. RESULTS In this institute, the valves used were predominantly mechanical (92.6 %) when compared to bioprosthesis in 7.4 % (47/632 valves - 23 mitral position and 24 in aortic position). The most common sizes used in the aortic and mitral position were 21 mm & 27 mm respectively. In spite of the seemingly lower sizes used in the patients undergoing double valve replacement (DVR) the incidence of PPM is less owing to the fact that the population under study had a lower body surface area (BSA) and body mass index (BMI) - 1.17 ± 0.3 & 19.86 ± 3.9 respectively. CONCLUSIONS It may be emphasized that if the valve size required to be implanted is derived based on the patient’s BSA and indexed effective orifice area, the incidence of patient prosthesis mismatch can be minimized drastically and with it the in-hospital mortality and morbidity. KEYWORDS Aortic Stenosis, Double Valve Replacement, Mitral Valve, Prosthesis, Rheumatic Heart Disease